Two Parkland nurses describe life inside their Dallas ICU in these first weeks of treating COVID-19 patients

‘It’s a very devastating bug,' Otto Madrigal says. Here’s what he and his colleague ask of us in return for their work on the front lines.

Registered nurses Megan Bennett and Otto Madrigal pose for a portrait outside Parkland Memorial Hospital in Dallas on Thursday after coming off their overnight shift. The two said a sense of optimism remains within their ICU. "When patients first got here, it took us some extra steps in getting ready and the room ready for patients, but now we've got the process streamlined," said Bennett, who is associate manager of the unit.(Lynda M. Gonzalez / Staff Photographer)

When Otto Madrigal finishes his 12-hour shift working among COVID-19 patients in a Parkland Memorial Hospital ICU, he trades his mask and surgical scrubs for the clothes he wore into work that day. When he gets home, he leaves his shoes in the garage, puts his clothes straight into the wash and heads for the shower — just as he has done every workday since he joined the hospital as a bedside nurse four years ago.

This virus is novel and deadly, the therapies that will prevent or cure it are yet unknown. Nevertheless, Madrigal said, caring for infected patients means using the same skills, the same knowledge, the same drilled-in procedures and the same human compassion with which he and other nurses greet every gravely ill patient.

Situations like this are “what I’ve been trained for,” he said. “It’s why we do what we do.”

Madrigal, 33, and his nursing colleague Megan Bennett, 36, take COVID-19 very, very seriously. They have seen it transform a patient in moderate distress into one struggling for his or her very life literally overnight.

“It’s a very devastating bug,” Madrigal told me in an early-morning interview just after he and Bennett wrapped up their deep-night shift Thursday.

“It’s very rapid, and it has a very profound impact on their health and well-being, sometimes leading to needing maximum medical support.”

That’s a gentle way of saying the patient will die without a ventilator.

Still, at this relatively early stage of the virus’s onslaught on North Texas, it has not turned Madrigal’s and Bennett’s world upside down or thrown them into a fever of anxiety about being overrun with patients the hospital is unprepared to care for.

They stare down death every day. It’s the job they have chosen, and they are glad to do it.

“We are accustomed to seeing people who don’t leave — and we see people who walk out of here and come back to see us,” Bennett told me.

More than anything, Bennett and Madrigal want us to understand that our lives and the lives of others depend on the choices we make day to day.

“You may have a great immune system, but you stand to hurt another person without even realizing it,” Bennett said. “People don’t realize that they aren’t just jeopardizing their life and their concerns, but they are potentially hurting other people’s lives.

“For them not to follow these rules and follow these mandates because they are healthy, it’s a selfish look,” she said.

What the two nurses ask of us in return for their work on the front lines is simple: Seek out reliable, factual information; resist the temptation to spread the rumors and hysteria circulating on social media; follow the directives and advice of infectious disease experts and the officials acting on their counsel.

In short, KEEP CALM AND STAY HOME.

Officials at Parkland Memorial Hospital in Dallas are not releasing the number of patients its medical staff has treated for COVID-19, but all its ICU units are handling cases.(Lynda M. Gonzalez / Staff Photographer)

“We’re being real when we say follow the guidelines,” Bennett said. “We’re being real when we say wash your hands, do your social distancing. Take it seriously.”

Madrigal put it this way: “I hope this doesn’t have to hit close to home before someone decides to make a different decision. You should start now.”

Madrigal decided to become a nurse after his newborn child required care in a neonatal intensive care unit. He was deeply moved by people who were strangers to him caring for his daughter as if she were their own.

“Being here right now, in this crisis of what’s going on throughout the country, I feel even more compelled to be on that front line and do everything I possibly can to help,” Madrigal said. “I just believe in getting up and showing up.”

The COVID-19 learning curve is steep, but hospitals are getting smarter with every case. And seeing results.

In addition to placing the patients in its just-opened 55-bed Tactical Care Unit, all of Parkland’s regular ICUs, a total of 89 beds, are handling these cases.

“It’s a learning process for sure,” Madrigal said. “But the more we’ve worked with this, it’s becoming more natural. We’re adapting but we have a strong foundation now.”

When one unit learns something that works — for example, extra steps related to personal protection equipment, or PPE — the message is broadcast hospital wide. “If something’s working, that information is going to go out,” Bennett said. “If it’s not, that information will go out too.”

The caregivers’ PPE garb — on top of surgical scrubs — includes gowns, gloves, masks (N95 and surgical), face shields and all types of gloves.

“Without the support of my colleagues, I wouldn’t be able to function properly and [would] be stressed,” Madrigal said of his overnight crew of about 25 caregivers in the 30-bed unit. “Having them side by side with me takes a weight off my back.”

Bennett, an associate manager on Madrigal’s unit, provides for the bedside caregivers’ needs “so that all they have to worry about when they come in is taking care of the patient.”

She makes sure that as nurses work with one or two patients each per shift, they have the necessary equipment and latest information. “Just being there for them in the sense of — if they need supplies, if they need meds, I can run get meds.”

Adding to the anxiety of ICU patients and their families is Parkland’s necessary decision to shut down all visitation in its attempts to seal out contagion. Nurses’ routines now include making lots of phone calls and helping connect the sick with their loved ones.

So far, Bennett and Madrigal are mostly working their regular hours — Bennett logging four 10-hour shifts a week and Madrigal three or four 12-hour shifts. The ICU is fast-paced and stressful on the best of days, so as long as Bennett is able, she tries to schedule the nurses as much downtime as possible.

The nurses are keenly aware of shortages in beds and personal protection equipment in other hospitals around the world, but for now, they say, the Parkland stockroom has had everything they need.

Bennett and Madrigal weren’t allowed to tell me how many COVID-19 patients they’ve treated, nor is Parkland making that information public.

But they trust that their employer has the resources in place to handle the patient load and keep everyone safe. They stake that confidence on Parkland’s transparency with its staff and say that caregivers in the trenches have been part of the planning.

Madrigal and Bennett said their health is great and they are micro-focused on keeping it that way. Like all employees, they have their temperature taken before they are allowed to enter the hospital each night.

They also swear that they don’t feel the least bit scared about reporting to work each day. “There are already so many extra steps that the hospital has put in place that I almost feel a little bit safer than working somewhere else,” Bennett said.

“I’m coming from a hospital that’s clean and going home to a house that is clean,” she said. “Of course, before I hug my daughter or touch a lot of things, I take that shower first.”

Bennett credits her 6-year-old with forcing work-life balance onto her. “We will go out in the backyard and go on a treasure hunt,” she said. “I’m blessed with having a kiddo who helps me take my mind off things.”

Madrigal’s daughter lives with her mother in El Paso, which is also his hometown. The nurse typically gets back there once or twice a month, but the coronavirus has halted those visits. “I don’t want to potentially expose my daughter or my parents or anyone else unnecessarily,” he said.

Madrigal acknowledged that staying in touch with his daughter can be a challenge, despite Facetime and other video technology. “But as long as I get to see her for a few seconds, I have to be content with that,” he said.

The last thing Bennett said before the nurses headed to their suburban homes for some much-earned sleep was: “We aren’t wearing rose-colored glasses. This is scary for a lot of people and why? It’s a pandemic.”

But ICU nurses can’t panic. They must follow processes. Ask for help when they need it. Know their limitations. Have a support system in place.

Even in this time of extraordinary stress, Madrigal said, he’s excited about going into work because he gets the chance to see critically ill patients improve. When that happens, “I feel this sense of accomplishment and like I made something a little better for this person.

Sharon Grigsby. I'm the Metro columnist, which means that if it's happening in North Texas, I'm likely to write about it. My work on Baylor's sexual assault scandal earned a spot as a 2018 Pulitzer finalist. I was born in Waco, raised my own family in the suburbs and have been back in Dallas ever since.